清养之下，弦滑脉象较昨颇缓，然肺受热伤每易成痿，不可不虑。
方加冬瓜子、丝爪络。
喘出于肾，关于肺。标本同源，病始而邪甚，继以正衰，大非久病所宜。热在上焦者，因
咳为肺痿，仲圣早已言之。非无意肺之一脏，外为热火所烁，内被肝火所逆，金不生水，水
不涵木，木反侮金，其畏如虎。转与复脉汤治其下，苇茎汤治其上，以冀弋获。
炙草 人参 生地 麦冬 阿胶 东瓜子 丝瓜络 莲根 苡米 川贝 知母 桑皮 骨皮 蛤壳
细绎病原，总不外乎燥之一字。燥万物者，莫燥乎火。火有虚实，火稍清而虚，火之上
炎不能归缩于下也。是以黄痰之外，更见粉红，舌干糙燥，便结小坚，肌肤干热，甚至手震
睡语，以昭热极生风，液涸风动之象焉。何必以脉之左者反浮、右者反细，而后知五志厥阳
之火亦从而暗燥之其金乎？当此肺已虚矣，束手无策，然又不能坐视。惟有资液救焚汤，虽
曰鞭长莫及，亦不得不以润万物者，莫悦乎泽之思，以冀吉人天相。
资液救焚汤
夏问伏暑，直至秋末而发，亦云晚矣。晚则其道远，其气深，横连于膜原，外发于阳明。
所以初发之时，仅见蒸热，难得汗泄，而不能解。今已二十日矣，曾经化火，发渴发干，阴分
必伤。伤阴化燥，本属暑邪见症，而况阳明中土万物所归，尤易化火伤津者乎？然阳明化火
伤津，不过清之养之而已，尚可有为。无如所患之症，火内挟饮食之积，结而不开，盘踞小
肠，上升则口糜，下注则便泄，泄还不已，转而为痢，其色黄而带灰白，便则多痛，以昭邪盛
则实之意焉。设使胃家气旺，肾脏不虚，而用攻克之剂，尚可以胜其任者，原为幸事然，而
饮食不思，神情困倦，面白带青，肌肉暗削，小便不多，少阳阳明两经之正气索然，津液先
涸，须急补助，已恐鞭长莫及也，岂能再用攻克？诊得右脉弦数，左脉细小。细小为虚，弦
数为实，虚中有实。法补实则碍虚，补虚又碍实，用药实为两难。惟有猪苓汤一法，最为瘀
后伤阴所合。然下焦可治，而中焦之结者、肝阴之亏者，仍未得以兼治，参入六一散方，佐
以芍药甘草汤，为一方而三法备焉之计，以冀弋获。否则悠悠而脱矣。候诸高明先生政之。
猪苓 阿胶 赤苓 泽泻 红曲 甘草 芍药 滑石 取荠菜花（一两） 荸荠（四个） 海蜇（一两）
煎汤代水。
复诊时，患者位于下焦的清养治疗使得原本弦滑的脉象比昨天明显缓和，然而肺脏受热邪损伤后容易形成痿证（指肢体筋脉弛缓、软弱无力，甚至肌肉萎缩的一种病证），这一点不可不加以忧虑。
处方中加入冬瓜子和丝瓜络。
喘证的根源在于肾，表现于肺。标本同源，疾病初期邪气盛实，随后正气衰败，这绝非久病的适宜状态。热邪在上焦，因咳嗽而发展为肺痿，张仲景早已论述过此理。并非仅仅针对肺这一脏器，而是外受热火灼烧，内被肝火逆冲，导致金（肺）不能生水（肾），水（肾）不能涵养木（肝），木反而反侮金（肺），其危害如同老虎般凶猛。转而采用复脉汤来治其下焦，苇茎汤来治其上焦，希望能获得疗效。
炙甘草 人参 生地 麦冬 阿胶 冬瓜子 丝瓜络 莲藕 薏苡仁 川贝母 知母 桑白皮 地骨皮 蛤壳
仔细推究病因，总离不开“燥”字。能使万物干燥的，没有比火更甚的了。火有虚火和实火之分，火势稍清则为虚火，火热上炎而不能收敛归元于下。因此，在咳出黄痰之外，又见粉红色痰液，舌面干枯粗糙，大便干结且小便短小坚硬，肌肤干燥发热，甚至出现手部震颤、睡中呓语，以显示热极生风、津液枯竭导致风动的征象。何必等到左脉反而浮大、右脉反而细弱，才知晓五志化火及厥阳之火也在暗中耗损肺金呢？此时肺脏已经虚弱，虽然束手无策，但也不能坐视不管。唯有使用资液救焚汤，虽说可能鞭长莫及，但也不得不抱持“滋润万物的，没有比泽润更好的”这一想法，希望得到上天庇佑，吉人天相。
夏季感受伏暑之邪，直到秋末才发作，也算晚了。发病晚则病位深远，病势深沉，横连于膜原（半表半里之间），向外发于阳明经。所以初发时，仅见蒸蒸发热，难以通过汗出而解除。如今已二十天了，曾经化火，出现口渴、口干，阴分必然受损。伤阴化燥，本属暑邪的典型症状，更何况阳明中土是万物所归之处，更容易化火伤津吗？然而阳明化火伤津，只需清热养阴即可，尚可为之。无奈患者所患之症，火热内挟饮食积滞，凝结而不散，盘踞在小肠，向上熏蒸则口舌生疮糜烂，向下注泄则大便溏泄，泄泻不止，进而转变为痢疾，粪便颜色黄而夹杂灰白色，排便时疼痛剧烈，以显示邪气盛实则表现为实证的意思。假如胃气旺盛，肾脏不虚，使用攻下消导的药剂，还可以胜任，这原本是幸事。然而，患者不思饮食，神情困倦，面色苍白带青，肌肉暗瘦，小便不多，少阳和阳明两经的正气索然无存，津液先已枯竭，急需补助，恐怕已经鞭长莫及了，怎么能再用攻下的方法呢？诊得右脉弦数，左脉细小。细小为虚，弦数为实，这是虚中有实的情况。法度上补实则碍虚，补虚又碍实，用药实在为难。唯有猪苓汤一法，最符合瘀热伤阴的病机。然而下焦可治，而中焦的结滞、肝阴的亏损，仍未得以兼顾治疗，加入六一散方，佐以芍药甘草汤，旨在通过一方具备三种治法，希望能获得疗效。否则病情将悠悠恶化直至脱失。敬请各位高明先生指正。
Upon the second visit, the previously wiry and slippery pulse has become considerably slower compared to yesterday following the nourishing and clearing treatment at the lower jiao. However, since lung injury by heat pathogens easily leads to Wei syndrome (a condition characterized by flaccidity and weakness of the limbs), this must not be overlooked.
The prescription is added with Benincasae Semen (Dongguazi) and Luffae Fibra Retinervata (Sigualuo).
Wheezing originates from the Kidney and manifests in the Lung. The root and branch share the same source; initially, the pathogen is excessive, followed by a decline in healthy Qi, which is not suitable for chronic illness. Heat in the upper jiao, leading to cough and developing into Fei Wei (Lung Flaccidity), was long ago discussed by Zhang Zhongjing. This is not merely about the Lung organ itself; externally scorched by fire-heat, internally reversed by Liver Fire, Metal (Lung) fails to generate Water (Kidney), and Water fails to nourish Wood (Liver). Consequently, Wood counter-rebels against Metal, causing harm as fierce as a tiger. We switch to treating the lower jiao with Guizhi Fuling Mu Dan Pi Tang (Fumai Tang) and the upper jiao with Weijing Decoction, hoping to achieve success.
Zhi Gancao (Prepared Licorice Root), Renshen (Ginseng Root), Shengdi Huang (Rehmannia Root), Maidong (Ophiopogon Tuber), Ejiao (Donkey-hide Gelatin), Dongguazi (Winter Melon Seed), Sigualuo (Luffa Fiber), Lian Gen (Lotus Rhizome), Yimi (Coix Seed), Chuan Bei Mu (Fritillaria Bulb), Zhimu (Anemarrhena Rhizome), Sang Bai Pi (Mulberry Root Bark), Gu Pi (Phellodendron Bark), Ge Qiao (Clam Shell).
Carefully analyzing the etiology, it essentially boils down to "Dryness." Nothing dries things more than Fire. Fire can be deficient or excess. If the fire is slightly cleared, it becomes deficient fire, where heat flares upward and cannot return to gather in the lower jiao. Therefore, besides yellow phlegm, pink sputum appears; the tongue is dry and rough; stool is constipated and hard, and urine is scant and firm; the skin and muscles are dry and hot; even hand tremors and sleep-talking occur, indicating that extreme heat generates wind and fluid depletion causes wind movement. Why wait until the left pulse becomes floating and the right pulse becomes thin to realize that the fire of the five emotions and Jueyang fire are also secretly drying the Metal? At this point, the Lung is already deficient. Although we seem helpless, we cannot sit idly by. We must only use Ziyao Jiufen Tang (Ziyao Jiufen Decoction). Although it may be too late to help, we must still think of "nothing moistens things better than dew," hoping for heavenly assistance to the virtuous.
Ziyao Jiufen Tang
Summer heat latent within, manifesting only at the end of autumn, is indeed late. Being late means the disease path is distant and the qi is deep, spreading horizontally to the Membrane Source (Moyuan) and outward to the Yangming channel. Thus, upon initial onset, only steaming fever is seen, difficult to resolve through sweating. It has now been twenty days. Having transformed into fire, it caused thirst and dryness, inevitably injuring the Yin aspect. Injury to Yin transforming into dryness is a typical symptom of summerheat pathogens. Moreover, Yangming Earth is where all things gather, making it prone to transforming into fire and injuring fluids. However, Yangming fire transforming and injuring fluids requires only clearing and nourishing, which is still manageable. Unfortunately, the patient's condition involves fire internalizing with food stagnation, knotting without opening, and occupying the Small Intestine. Ascending, it causes mouth sores; descending, it causes diarrhea. Persistent diarrhea turns into dysentery, with yellow stool mixed with gray-white matter, accompanied by severe pain during defecation, indicating that excess pathogens manifest as excess syndromes. If the Stomach Qi were robust and the Kidneys not deficient, using purgative agents might succeed, which would be fortunate. However, the patient has no appetite, looks exhausted, face is pale with a bluish tint, muscles are emaciated, and urine is scant. The healthy Qi of both Shaoyang and Yangming channels is depleted, and fluids are first exhausted. Urgent supplementation is needed, yet it may already be too late. How can we use purgatives? The right pulse is wiry and rapid; the left pulse is fine and small. Fine and small indicate deficiency; wiry and rapid indicate excess. This is deficiency containing excess. Treating excess hinders deficiency; tonifying deficiency hinders excess. Medication is truly difficult. Only Zhu Ling Tang (Polyporus Decoction) fits best for post-stasis Yin injury. However, while the lower jiao can be treated, the knotting in the middle jiao and the deficiency of Liver Yin remain untreated. Adding Liu Yi San (Six-to-One Powder) and assisting with Shaoyao Gancao Tang (Peony and Licorice Decoction) aims to prepare three methods in one formula, hoping for success. Otherwise, the condition will deteriorate into collapse. Submitted for correction by esteemed experts.
Zhuling (Polyporus), Ejiao (Donkey-hide Gelatin), Chiling (Red Polyporus), Zexie (Alisma Rhizome), Hongqu (Red Yeast Rice), Gancao (Licorice Root), Shaoyao (Peony Root), Huashi (Talcum), Jicaihua (Shepherd's Purse Flower, 1 liang), Biqi (Water Chestnut, 4 pieces), Haizhe (Sea Cucumber, 1 liang). Decoct these to replace water.